Individual
LESLEY ANN DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
500 NE MULTNOMAH ST, PORTLAND, OR 97232-2023
(503) 407-0834
Mailing address
11481 SW HALL BLVD, SUITE 201, PORTLAND, OR 97223-8403
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5827
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0245678
WASHINGTON L & I
OR
05
—
500604267
—
OR
01
—
P00802457
RR MEDICARE
OR
Enumeration date
01/22/2009
Last updated
03/06/2022
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